Incidence and identification of intrathecal baclofen catheter malfunction. PM R 2010 Aug;2(8):751-6
Date
07/06/2010Pubmed ID
20598957DOI
10.1016/j.pmrj.2010.01.016Scopus ID
2-s2.0-77955657000 (requires institutional sign-in at Scopus site) 37 CitationsAbstract
OBJECTIVE: A retrospective chart review was undertaken of cases of intrathecal baclofen (ITB) pump/catheter malfunction and the diagnostic tests performed to identify the problem. An internal review was performed to develop a diagnostic flow chart to have a systematic method for identifying ITB pump and catheter complications.
DESIGN: Retrospective chart review.
SETTING: Tertiary care hospital.
PARTICIPANTS: A total of 167 adult patients currently followed in outpatient clinic with intractable spasticity and ITB pump implanted between January 1994 and May 2009.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Catheter malfunction was identified either by anterior/posterior and lateral thoracic/lumbar radiographs, fluoroscopic guided side port access, contrast agent injection followed by CT (fluoro/CT) scan, or indium radionuclide studies.
RESULTS: During the study period, 33 patients had 37 catheter revisions. Radiographs were obtained in all cases; fluoro/CT studies in 22, and indium studies in 6. Four cases had both fluoro/CT and indium studies. A total of 13 cases (35.1%) were diagnosed with radiographs; 9 cases (24.3%) were diagnosed by inability to withdraw cerebral spinal fluid from the side port; 13 cases (35.1%) were diagnosed with fluoro/CT studies; and 2 cases (5.4%) were diagnosed with indium studies. Fluoro/CT studies demonstrated subdural catheter location in 7 cases. A total of 2 of 4 cases with both fluoro/CT and indium studies had normal-appearing indium scans and an abnormal fluoro/CT study confirming subdural catheter placement.
CONCLUSIONS: On the basis of an internal review of the diagnostic studies used to identify patients with suspected ITB pump/catheter malfunction, a troubleshooting flow chart was developed. Timely identification and correction of potential ITB complications could improve the clinical effectiveness of ITB and may reduce unnecessary health-care costs.
Author List
Dvorak EM, McGuire JR, Nelson MEAuthors
John R. McGuire MD Professor in the Physical Medicine and Rehabilitation department at Medical College of WisconsinMary Elizabeth S. Nelson-Biersach DNP, NP Assistant Professor Outpatient in the Physical Medicine and Rehabilitation department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Baclofen
Catheters
Child
Child, Preschool
Cohort Studies
Equipment Failure
Female
Humans
Incidence
Infant
Infusion Pumps, Implantable
Injections, Spinal
Male
Middle Aged
Muscle Relaxants, Central
Muscle Spasticity
Retrospective Studies
Young Adult
